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How did Communist parties handle issues of internal discipline and democracy in Lenin’s time? The recent intense discussion within the British Socialist Workers’ Party (SWP) and beyond has heard claims that the SWP rests on the traditions of democratic centralism inherited from the Bolsheviks.

Richard Atkinson: Death and the Bedroom Tax

Some extended thoughts about Stephanie Bottrill, the woman who committed suicide because of the bedroom tax.

Dave Renton: Who Was Blair Peach?

Today marks the 35th anniversary of the killing of Blair Peach by the police. David Renton looks back at Blair Peach’s life as a poet, trade unionist and committed antifascist

How can we save the NHS?

What will it take to save the NHS? Almost all avenues have been tried in one way or another. This pamphlet attempts to advance a strategy for uniting the different forces involved in NHS campaigns into a movement which can mobilize the great mass of NHS staff and our patients, the public, in the mass social movement that is needed to halt the programme of cuts and privatisation dismantling the NHS. It does not focus on the attacks, by successive Tory and Labour governments, but rather the response of unions, professional bodies and grassroots activists.

Nothing about the destruction of the NHS is inevitable. The NHS is one of the largest organisations on the planet, and the largest healthcare organisation in the world. It employs 1.2 million people directly, and an estimated 6 million indirectly. Its dismantling is a long term political project which has taken over 30 years.

The process, started under Thatcher and maintained by Labour, has now been brought to its final heightened frenzy by the Tory-Liberal coalition. It has been driven by the needs of the market, had its way greased with lobbyist money, and enabled by politicians and political parties having abandoned principles in favour of corporate careers and the revolving door between ministerial posts and the private sector. They have enabled a massive transfer of wealth from the public to the private sector, at the price of massive suffering for patients, their families and staff.

The attacks on the NHS have been resisted, but nothing has been able to halt them. Partly this is due to the determination of government and their corporate health backers, but has also been assisted by compliance and collusion from those organisations which are tasked with protecting and improving the NHS for its workers and the public.

The NHS under Labour

When Labour was elected they pumped huge amounts of funding into the NHS, rescuing it from the decades of underfunding under the previous Tory government. They also committed to funnelling large chunks of this money to the private sector through allowing the commissioning of services by the NHS, and instruments like the Private Finance Initiative (PFI). The private healthcare market, which was tiny at the turn of the century, was given much needed support and funds in the form of lucrative contracts for NHS work.

The NHS budget was increased, but rather than increasing NHS capacity, independent sector treatment centres (ISTCs) were contracted to reduce NHS waiting lists. Private companies began to cherry pick “easy” operations and function as parasites on the NHS budget, absorbing huge sums for work that was incomplete, poorly done and even dangerous. Nevertheless the funds grew the private sector and set them up for taking over larger contracts in the future. During this time there was a revolving door between the Department of Health (DH) and the private sector as health ministers and DH bureaucrats moved between government positions and private healthcare companies or management consultants.

During the 13 years of the Labour government, pro-Labour trade union officials sat on every attempt to organise resistance to Labour's privatisations. Where action was organised, it was limited, tokenistic and ineffectual. An example of this is the case of NHS Logistics. This highly profitable department was contracted out to DHL with only two days of strike action organised by UNISON, barely a week before the contract with DHL was due to start. The last minute action without any attempt to mobilise the public or other sections of the NHS workforce failed. It was emblematic of much of the union leadership’s response to NHS cuts and privatisation. Last minute, disorganised and tokenistic actions, which inevitably ended in defeat and demoralisations.

Those health worker activists at the grassroots level who organised effective action to stop cuts and privatisation were marginalized and bullied when they attempted to stand up to Labour policy, and where they wouldn't back down or shut up were witchhunted out of their unions and their jobs. Union militants were forced out, and entire branches smashed up in order to allow Labour government policy to be enforced.

Campaigns like “NHS Together” and “Keep the NHS working” were launched by the union leaderships, claiming to unite all the health unions in opposition to growing commercialisation in the NHS. But these were top down, bureaucratically controlled campaigns. Union members had no say in how these campaigns were run, and were just wheeled out for rallies and meetings occasionally. Neither NHS Together nor Keep the NHS working never organised any concrete action to oppose Labour's policies. When the union leaderships couldn't contain anger at cut backs any longer, as in the 2006-2007 period when 20,000 NHS workers lost their jobs, they organised a toothless demonstration in November 2007 of just 7,000 people under the depoliticised slogan “I <3 NHS”. The demonstration served to blow off steam for the workforce but didn't challenge government policy.

Due to its continued agitation about Labour's detrimental policy towards the NHS, Keep Our NHS Public was unofficially made a proscribed organisation by UNISON's leadership, and branches were told they could not organise events with KONP, affiliate to it or donate money to it. In 2009 a motion went to UNISON conference to overturn this unofficial rule and was passed, but UNISON nationally still does not sponsor KONP, although individual branches can and do support them.

The end result was that, even though under Labour there was widespread opposition to NHS privatisation in the general public and among NHS staff, this was never able to cohere into a national movement which could stop or reverse Labour's policies. The process Labour started was to be accelerated under the Tories, until we faced the prospect of the destruction of the entire NHS as we knew it. Unfortunately despite Labour being out of power, the same inaction, corruption and political compromise plagued the unions under the Tory-Liberal government.